Readjustment Stressors and Early Mental Health Treatment Seeking by Returning National Guard Soldiers With PTSD
Abstract
OBJECTIVES: Readjustment stressors are commonly encountered by veterans returning from combat operations and may help motivate treatment seeking for posttraumatic stress disorder (PTSD). The study examined rates of readjustment stressors (marital, family, and employment) and their relationship to early mental health treatment seeking among returning National Guard soldiers with PTSD. METHODS: Participants were 157 soldiers who were surveyed approximately three months after returning from combat operations in Iraq and scored positive on the PTSD Checklist (PCL). The survey asked soldiers about their experience with nine readjustment stressors as well as their use of mental health care in the three months after returning. RESULTS: Many readjustment stressors were common in this cohort, and most soldiers experienced at least one stressor (72%). Univariate analyses showed that readjustment stressors were related to higher rates of treatment seeking. These findings remained significant after multivariate analyses adjusted for depression and PTSD severity but were no longer significant after adjustment for age and marital status. CONCLUSIONS: Readjustment stressors are common among soldiers returning from duty with PTSD and may be more predictive than PTSD symptom levels in treatment seeking. These effects appeared to be at least partially accounted for by demographic variables and the role of greater familial and occupational responsibilities among older veterans. Treatment seeking may be motivated by social encouragement or social interference and less by symptom severity.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Difficulties with adjustment and reintegration are associated with poorer outcomes in mental health, social and family relationships, employment and financial security, physical health, and stable housing.
“Difficulties with adjustment and reintegration are associated with poorer outcomes in mental health [5], social and family relationships [1, 9–11], employment and financial security [1,2,12), physical health [12] and stable housing [13, 14].”
From Feasibility, acceptability, and initial outcomes of a psychological adjustment and reintegration program for transitioned military veterans (2024) · cites this paper as [9]
Cites
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005) · Archives of General Psychiatry · doi:10.1001/archpsyc.62.6.593 · Cited by 20,391 · see citing works
The PHQ-9: A New Depression Diagnostic and Severity Measure
Kroenke, K., & Spitzer, R. L. (2002) · Psychiatric Annals · doi:10.3928/0048-5713-20020901-06 · Cited by 5,898 · see citing works
Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care
Hoge, C. W., Castro, C. A., Messer, S. C., McGurk, D., Cotting, D. I., & Koffman, R. L. (2004) · New England Journal of Medicine · doi:10.1056/nejmoa040603 · Cited by 4,778 · see citing works
Psychometric properties of the PTSD checklist (PCL)
Blanchard, E. B., Jones-Alexander, J., Buckley, T. C., & Forneris, C. A. (1996) · Behaviour Research and Therapy · doi:10.1016/0005-7967(96)00033-2 · Cited by 3,997 · see citing works
Wang, P. S., Berglund, P., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2005) · Archives of General Psychiatry · doi:10.1001/archpsyc.62.6.603 · Cited by 1,325 · see citing works
A prospective examination of post‐traumatic stress disorder in rape victims
Rothbaum, B. O., Foa, E. B., Riggs, D. S., Murdock, T., & Walsh, W. (1992) · Journal of Traumatic Stress · doi:10.1002/jts.2490050309 · Cited by 1,097 · see citing works
Thomas, J. L., Wilk, J. E., Riviere, L. A., McGurk, D., Castro, C. A., & Hoge, C. W. (2010) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2010.54 · Cited by 935 · see citing works
Foa, E. B., Hembree, E. A., Cahill, S. P., Rauch, S. A. M., Riggs, D. S., Feeny, N. C., & Yadin, E. (2005) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.73.5.953 · Cited by 931 · see citing works
Cognitive processing therapy for veterans with military-related posttraumatic stress disorder.
Monson, C. M., Schnurr, P. P., Resick, P. A., Friedman, M. J., Young‐Xu, Y., & Stevens, S. P. (2006) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.74.5.898 · Cited by 860 · see citing works
Resick, P. A., Galovski, T. E., Uhlmansiek, M. O., Scher, C. D., Clum, G. A., & Young-Xu, Y. (2008) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.76.2.243 · Cited by 825 · see citing works
Sayer, N. A., Noorbaloochi, S., Frazier, P., Carlson, K., Gravely, A., & Murdoch, M. (2010) · Psychiatric Services · doi:10.1176/ps.2010.61.6.589 · Cited by 527 · see citing works
Seal, K. H., Maguen, S., Cohen, B. E., Gima, K. S., Metzler, T. J., Ren, L., Bertenthal, D., & Marmar, C. R. (2010) · Journal of Traumatic Stress · doi:10.1002/jts.20493 · Cited by 418 · see citing works
(1997) · JAMA: The Journal of the American Medical Association · doi:10.1001/jama.1997.03540270064028 · Cited by 396 · see citing works
A qualitative study of determinants of PTSD treatment initiation in veterans
Sayer, N. A., Friedemann-Sanchez, G., Spoont, M., Murdoch, M., Parker, L. E., Chiros, C., & Rosenheck, R. (2009) · Psychiatry: Interpersonal and Biological Processes · doi:10.1521/psyc.2009.72.3.238 · Cited by 288 · see citing works
Keane, C. (2008) · Journal of Management Inquiry · doi:10.1177/1056492607313233 · Cited by 241 · see citing works
Employment Outcomes and PTSD Symptom Severity
Smith, M. W., Schnurr, P. P., & Rosenheck, R. A. (2005) · Mental Health Services Research · doi:10.1007/s11020-005-3780-2 · Cited by 203 · see citing works
Prigerson, H. G., Maciejewski, P. K., & Rosenheck, R. A. (2001) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-200102000-00005 · Cited by 197 · see citing works
Sayer, N. A., Frazier, P., Orazem, R. J., Murdoch, M., Gravely, A., Carlson, K. F., Hintz, S., & Noorbaloochi, S. (2011) · Journal of Traumatic Stress · doi:10.1002/jts.20706 · Cited by 180 · see citing works
Seal, K. H., Bertenthal, D., Maguen, S., Gima, K. S., Chu, A. T., & Marmar, C. R. (2008) · American Journal of Public Health · doi:10.2105/ajph.2007.115519 · Cited by 123 · see citing works
Early mental health treatment‐seeking among U.S. National Guard soldiers deployed to Iraq
Kehle, S. M., Polusny, M. A., Murdoch, M., Erbes, C. R., Arbisi, P. A., THURAS, P. D., & Meis, L. A. (2010) · Journal of Traumatic Stress · doi:10.1002/jts.20480 · Cited by 117 · see citing works
Coming home may hurt: risk factors for mental ill health in US reservists after deployment in Iraq
Riviere, L. A., Kendall-Robbins, A., McGurk, D., Castro, C. A., & Hoge, C. W. (2011) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.110.084863 · Cited by 87 · see citing works
Suicidal Ideation Among National Guard Troops Deployed to Iraq
Kline, A., Ciccone, D. S., Falca-Dodson, M., Black, C. M., & LOSONCZY, M. F. (2011) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0b013e3182392917 · Cited by 76 · see citing works
Self-citationThe utility of the SCL-90-R for the diagnosis of war-zone related posttraumatic stress disorder
Weathers, F. W., Litz, B. T., Keane, T. M., Herman, D. S., Steinberg, H. R., Huska, J. A., & KRAEMER, H. C. (1996) · Journal of Traumatic Stress · doi:10.1007/bf02116837 · Cited by 51 · see citing works
Race and ethnicity as factors in mental health service use among veterans with PTSD
Spoont, M. R., Hodges, J., Murdoch, M., & Nugent, S. (2009) · Journal of Traumatic Stress · doi:10.1002/jts.20470 · Cited by 45 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
A brief introduction to the military workplace culture
Redmond, S. A., Wilcox, S. L., Campbell, S., Kim, A., Finney, K., Barr, K., & Hassan, A. M. (2015) · WORK: A Journal of Prevention, Assessment & Rehabilitation · doi:10.3233/wor-141987 · Cited by 169 · see citing works
SYMPTOM BENCHMARKS OF IMPROVED QUALITY OF LIFE IN PTSD
Schnurr, P. P., & Lunney, C. A. (2016) · Depression and Anxiety · doi:10.1002/da.22477 · Cited by 107 · see citing works
Military service member and veteran reintegration: A critical review and adapted ecological model.
Elnitsky, C., Blevins, C. L., Fisher, M., & Magruder, K. M. (2017) · American Journal of Orthopsychiatry · doi:10.1037/ort0000244 · Cited by 106 · see citing works
Smith, J. R., Workneh, A., & Yaya, S. (2019) · Journal of Traumatic Stress · doi:10.1002/jts.22456 · Cited by 93 · see citing works
The deadly gap: Understanding suicide among veterans transitioning out of the military
Sokol, Y., Gromatsky, M. A., Edwards, E. R., Greene, A. L., Geraci, J. C., Harris, R. E., & Goodman, M. S. (2021) · Psychiatry Research · doi:10.1016/j.psychres.2021.113875 · Cited by 87 · see citing works
Interian, A., Kline, A., Janal, M. N., Glynn, S. M., & LOSONCZY, M. F. (2014) · Journal of Traumatic Stress · doi:10.1002/jts.21885 · Cited by 51 · see citing works
Self-citationKukla, M., Rattray, N. A., & Salyers, M. P. (2015) · The Journal of Rehabilitation Research and Development · doi:10.1682/jrrd.2014.11.0289 · Cited by 51 · see citing works
Sripada, R. K., Pfeiffer, P. N., Rauch, S. A. M., & Bohnert, K. M. (2014) · Psychiatric Services · doi:10.1176/appi.ps.201400029 · Cited by 49 · see citing works
Sripada, R. K., Bohnert, A. M., Teo, A. R., Levine, D. S., Pfeiffer, P. N., Bowersox, N. W., Mizruchi, M. S., Chermack, S. T., Ganoczy, D. A., Walters, H., et al. (2015) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-015-1078-2 · Cited by 37 · see citing works
Reculturation: A new perspective on military-civilian transition stress
Joseph, J. S., Smith‐MacDonald, L., Filice, M. C., & Smith, M. S. (2022) · Military Psychology · doi:10.1080/08995605.2022.2094175 · Cited by 36 · see citing works
Romaniuk, M., Fisher, G., Kidd, C., & Batterham, P. J. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-02936-y · Cited by 35 · see citing works
A scope of the problem: Post-deployment reintegration challenges in a National Guard Unit
Wilcox, S. L., Oh, H., Redmond, S. A., Chicas, J., Hassan, A. M., Lee, P.-J., & Ell, K. (2015) · Work · doi:10.3233/wor-141935 · Cited by 34 · see citing works
Monk, J. K., Ogolsky, B. G., & Bruner, V. (2016) · Journal of Couple & Relationship Therapy · doi:10.1080/15332691.2015.1089803 · Cited by 26 · see citing works
Mental health service use in Australia: The role of family structure and socio-economic status
Vu, B. T., Biswas, R. K., Khanam, R., & Rahman, M. (2018) · Children and Youth Services Review · doi:10.1016/j.childyouth.2018.08.001 · Cited by 25 · see citing works
Misra-Hebert, A. D., Santurri, L., DeChant, R., Watts, B., Rothberg, M., Sehgal, A. R., & Aron, D. C. (2015) · Southern Medical Journal · doi:10.14423/smj.0000000000000326 · Cited by 22 · see citing works
Geraci, J. C., Mobbs, M. C., Edwards, E. R., Doerries, B., Armstrong, N. J., Porcarelli, R., Duffy, E., Loos, C. M., Kilby, D. J., Juanamarga, J., et al. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.01907 · Cited by 22 · see citing works
Geraci, J. C., Murray, C., Kapil-Pair, K. N., Herrera, S. N., Sokol, Y., Cary, J., Landa, Y., & Goodman, M. S. (2020) · Journal of Clinical Psychology · doi:10.1002/jclp.22923 · Cited by 21 · see citing works
Geraci, J. C., Dichiara, A., Greene, A. L., Gromatsky, M. A., Finley, E. P., Kilby, D. J., Frankfurt, S. B., Edwards, E. R., Kurz, A. S., Sokol, Y., et al. (2023) · Psychological Services · doi:10.1037/ser0000764 · Cited by 23 · see citing works
PTSD in Active Combat Soldiers: To Treat or Not to Treat
Wangelin, B. C., & Tuerk, P. W. (2014) · The Journal of Law Medicine & Ethics · doi:10.1111/jlme.12132 · Cited by 17 · see citing works
A systematic review and meta-analysis of the traumatogenic phenotype hypothesis of psychosis
Onyeama, F., Melegkovits, E. A., Yu, N., Parvez, A., Rodrigues, A., Billings, J., Kelleher, I., Cannon, M. D., & Bloomfield, M. (2024) · BJPsych Open · doi:10.1192/bjo.2024.52 · Cited by 12 · see citing works
Wimalawansa, S. J. (2013) · Asian Journal of Medical Sciences · doi:10.3126/ajms.v5i2.8537 · Cited by 13 · see citing works
Levine, D. S., Sripada, R., Ganoczy, D., Walters, H. M., Gorman, L. A., & Valenstein, M. (2016) · Military Medicine · doi:10.7205/milmed-d-15-00287 · Cited by 9 · see citing works
Harrod, M., Miller, E. M., Henry, J., & Zivin, K. (2017) · Work · doi:10.3233/wor-172551 · Cited by 12 · see citing works
Sharifian, N., LeardMann, C. A., Kolaja, C. A., Baccetti, A., Carey, F. R., Castañeda, S. F., Hoge, C. W., & Rull, R. P. (2024) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2024.10.006 · Cited by 10 · see citing works
Resilience and Veteran Community Reintegration: An Exploratory Study
Castillo, E. A., Mason, J., D’Addario, A., Chow, G. M., & Tenenbaum, G. (2019) · Military Behavioral Health · doi:10.1080/21635781.2018.1534702 · Cited by 10 · see citing works
Cognitive-Behavioral Conjoint Therapy for PTSD: Application to an Operation Enduring Freedom Veteran
Blount, T. H., Fredman, S. J., Pukay‐Martin, N. D., Macdonald, A., & Monson, C. M. (2014) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2014.05.001 · Cited by 10 · see citing works
Mental Health Service Use in a Representative Sample of National Guard Soldiers
Goodwin, R. D., Cohen, G. H., Tamburrino, M., Calabrese, J. R., Liberzon, I., & Galea, S. (2014) · Psychiatric Services · doi:10.1176/appi.ps.201300282 · Cited by 10 · see citing works
Nelson, C. B., Zivin, K., Walters, H., Ganoczy, D. A., Wadsworth, S. M., & Valenstein, M. M. (2015) · Psychiatric Services · doi:10.1176/appi.ps.201400334 · Cited by 9 · see citing works
Families of returned defence force personnel: a changing landscape of challenges
Berle, D., & Steel, Z. (2015) · Australasian Psychiatry · doi:10.1177/1039856215590031 · Cited by 9 · see citing works
Differential association between unemployment status and mental health among veterans and civilians
Tran, T. V., Canfield, J., & Chan, K. (2016) · Social Work in Mental Health · doi:10.1080/15332985.2016.1229714 · Cited by 9 · see citing works
Griffith, J. E. (2019) · Military Psychology · doi:10.1080/08995605.2019.1565908 · Cited by 10 · see citing works
Post-Traumatic Stress Disorder: An Under-Diagnosed and Under-Treated Entity
Wimalawansa, S. S. (2013) · Cited by 8 · see citing works
Romaniuk, M., Saunders-Dow, E., Brown, K., & Batterham, P. J. (2024) · BMC Psychology · doi:10.1186/s40359-024-02097-7 · Cited by 7 · see citing works
“Difficulties with adjustment and reintegration are associated with poorer outcomes in mental health [5], social and family relationships [1, 9–11], employment and financial security [1,2,12), physical health [12] and stable housing [13, 14].”
BackgroundSegal, A. G., Diaz, C. E., Nezu, C. M., & Nezu, A. M. (2014) · Military Behavioral Health · doi:10.1080/21635781.2014.963760 · Cited by 7 · see citing works
Goldberg, S. B., Flynn, A. W. P., Abbas, M., Schultz, M. E., Hiserodt, M., Thomas, K. A., Kallio, K. C., & Wyman, M. F. (2022) · The Counseling Psychologist · doi:10.1177/00110000221074019 · Cited by 5 · see citing works
Socioeconomic Status and Mental Health Service Use Among National Guard Soldiers
Sripada, R. K., Richards, S. K. H., Rauch, S. A. M., Walters, H., Ganoczy, D. A., Bohnert, K. M., Gorman, L. A., Kees, M. R., Blow, A. J., & Valenstein, M. M. (2015) · Psychiatric Services · doi:10.1176/appi.ps.201400346 · Cited by 5 · see citing works
National Guard Service Member Reintegration Experiences: The Transition Back Home
Sripada, R. K., Walters, H., Forman, J. H., Levine, D. S., Pfeiffer, P. N., Bohnert, K. M., Emerson, L., & Valenstein, M. M. (2017) · Military Behavioral Health · doi:10.1080/21635781.2017.1412841 · Cited by 4 · see citing works
Nonpathologic Postdeployment Transition Symptoms in Combat National Guard Members and Reservists.
Mitchell, K. (2017) · Europe PMC (PubMed Central) · Cited by 4 · see citing works
Veteran Mental Health and Employment: The Nexus and Beyond
Nelson, C. B., Abraham, K. M., Miller, E. M., Kees, M. R., Walters, H., Valenstein, M. M., & Zivin, K. (2015) · Springer eBooks · doi:10.1007/978-3-319-21488-7_13 · Cited by 4 · see citing works
Edwards, E. R., Coolidge, B., Ruiz, D., Epshteyn, G., Krauss, A., Gorman, D., Connelly, B., Redden, C., El-Meouchy, P., & Geraci, J. C. (2023) · Suicide and Life-Threatening Behaviour · doi:10.1111/sltb.12970 · Cited by 3 · see citing works
Vogt, D. S., Danitz, S. B., Fox, A. B., Sanders, W., & Smith, B. N. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2018.12.031 · Cited by 3 · see citing works
Kintzle, S. M., Oh, H., Wilcox, S. L., Hassan, A. M., Ell, K., & Castro, C. C. (2015) · Military Medicine · doi:10.7205/milmed-d-14-00466 · Cited by 2 · see citing works
The Influence of Just World Beliefs on the Stigmatization of Combat-Related PTSD
Tyler, H. C., & Frey, L. L. (2019) · Military Behavioral Health · doi:10.1080/21635781.2018.1550025 · Cited by 1 · see citing works
Stigma and Treatment Seeking by Service Members and Veterans
Murphy, J. P. (2012) · Psychiatric Services · doi:10.1176/appi.ps.631203 · Cited by 1 · see citing works
Hanrahan, N. P., Judge, K., Olamijulo, G. B., Seng, L., Lee, M., Wall, P. H., Leake, S. C., Czekanski, E., Thorne-Odem, S., DeMartinis, E. E., et al. (2016) · The Nurse Practitioner · doi:10.1097/01.npr.0000488717.90314.62
National Guard Members with Suicide Ideation
Brown, A. (2020) · UKnowledge (University of Kentucky) · doi:10.13023/etd.2020.453
Romaniuk, M., Fisher, G., Kidd, C., & Batterham, P. J. (2020) · Figshare · doi:10.6084/m9.figshare.13212197
Romaniuk, M., Fisher, G., Kidd, C., & Batterham, P. J. (2020) · Figshare · doi:10.6084/m9.figshare.13212212
Romaniuk, M., Fisher, G., Kidd, C., & Batterham, P. J. (2020) · Figshare · doi:10.6084/m9.figshare.13212209
Romaniuk, M., Fisher, G., Kidd, C., & Batterham, P. J. (2020) · Figshare · doi:10.6084/m9.figshare.13212203
Romaniuk, M., Fisher, G., Kidd, C., & Batterham, P. J. (2020) · Figshare · doi:10.6084/m9.figshare.13212194
The Rural WAVE (Wellness and Veteran Engagement) Initiative
Parry, K. J., Blue, C. M., Clark, S. C., Conzemius, J. L., Hale-Gallardo, J. L., Halliburton, L., Hicken, B. L., Lanford, T. J., Lynch, C., Miao, J. W., et al. (2026) · The Journal of Rural Health · doi:10.1111/jrh.70211
- Authors
- Interian, A., Kline, A., Callahan, L., & Losonczy, M.
- Affiliations
- Rutgers, The State University of New Jersey (US)
- Venue
- Psychiatric Services
- Published
- 2012-09
- Volume
- 63
- Issue
- 9
- Pages
- 855-861
- ISSN
- 0022-1597 (ISSN-L)
- 1075-2730
- 1557-9700
- OpenAlex
- W2106407184
- Cited by
- 53
- References
- 24
- Citations by year
- 2026: 1 · 2024: 3 · 2023: 3 · 2022: 2 · 2021: 1 · 2020: 9 · 2019: 4 · 2018: 2 · 2017: 4 · 2016: 5 · 2015: 10 · 2014: 6 · 2013: 2 · 2012: 1
- FWCI
- 6.90
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychiatric Services (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Education › Education and Military Integration
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Keywords
- post-traumatic stress disorder, mental health treatment seeking, returning soldiers, National Guard, Iraq War veterans, marital stress, family stress, occupational stress, social interference, older veterans
- MeSH terms
- Adolescent, Adult, Aged, Female, Health Surveys, Humans, Male, Middle Aged, Military Personnel, Patient Acceptance of Health Care, Social Adjustment, Stress Disorders, Post-Traumatic, Time Factors, United States, Veterans, Iraq War, 2003-2011, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
